Individual
TANISHA MARIE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
703 GODWIN ST, PORTSMOUTH, VA 23704-4009
(757) 227-7708
Mailing address
703 GODWIN ST, PORTSMOUTH, VA 23704-4009
(757) 227-7708
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
15270170
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15270170
—
VA
Enumeration date
04/13/2022
Last updated
04/13/2022
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